负钠梯度透析对处于干体重的透析患者高血压的影响

目的：拟观察负钠梯度透析对已处于干体重的血液透析（ HD）患者高血压的影响。方法：研究入选16例生物电阻抗法评估已处于干体重的透析高血压患者,透析前血钠浓度高于138 mmol/L。以本透析中心标准透析液（ Na＋浓度为138 mmol/L）透析1个月作为基线,降低透析液Na＋浓度至136 mmol/L透析4个月。期间不改变患者饮食钠摄入量,每月使用生物电阻抗技术调整透析后容量状况始终维持在正常范围并相对稳定,观察对家庭血压（ Home BP）和透析间期体重增长（IDWG）等的影响。结果：（1）增加负钠梯度2 mmol/L后,降压药用量无明显变化的情况下,家庭血压从第2个月开始明显下降,4个月后家庭血压收缩压（Home SBP）下降14.6 mmHg（P〈0.001）;家庭血压舒张压（Home DBP）下降9.6 mmHg,P=0.003。（2）透析后容量状况正常且无明显变化;透析间期体重增长率从（4.81±1.51）%降至（4.36±1.37%）,P=0.047。结论：对于处于干体重的透析高血压患者,负钠梯度透析可能具有独立于容量的降压作用。

Effects of Negative Sodium Gradient Dialysis on Hypertension in Hemodialysis Patients on Dry Weight

Objective：To observe the effects of increasing sodium diffusive removal by the negative sodium gradient dialysis on blood pressure in hemodialysis patients on dry weight. Methods：16 hypertensive hemodialysis patients on dry weight were enrolled, whose predialysis plasma sodium levels were higher than 138 mmol/L,After a 1-month period with standard dialysate sodium concen-tration of 138 mmol/L（ baseline） ,the patients were followed up for a 4-month period with dialysate sodium set at 136 mmol/L,with-out change in instructions to patients about dietary sodium intake. During the period of study,the dry weight was adjusted under the guidance of bioimpedance spectroscopy,to maintain post-dialysis volume status within normal range. The changes of home blood pres-sure and interdialytic weight gain were recorded. Results：（1） Home blood pressure progressively decreased, attained statistical signif-icance by the end of month 2;there was an average fall of 14. 6 mmHg in home systolic blood pressure and 9. 6mmHg in home dias-tolic blood pressure by the end of month 4. （2） The post-dialysis volume parameters remained constant throughout the study period. Interdialytic weight gain adjusted to the estimated dry weight mildly but significantly decreased （ 4. 81 ±1. 51 ）% vs （ 4. 36 ±1. 37）%,p=0. 047）. Conclusion：In selected hypertensive hemodialysis patients on dry weight, negative sodium gradient dialysis re-sulted in significant blood pressure decrease. It was most likely due to the volume-independent effect.